Every 2 seconds a blood transfusion is needed in the United States. That means that every 2 seconds, a unit of blood must be screened, typed, matched, and safely transported along the bloodline that connects the generosity of a blood donor to the need of a patient.
Susan D. Kadri, vice president, Ortho Clinical Diagnostics (OCD) Transfusion Medicine Marketing, leads OCD’s Transfusion Medicine and Donor Screening Marketing teams in their efforts to understand the needs of today’s blood bankers and deliver science-driven products and solutions
And behind the scenes every day, ensuring the safety of these bloodlines, are blood bankers working to ensure compatible blood is available where and when it’s needed. While technology has made many routine tasks faster and easier, the demand for blood continues to increase and the need to process blood more efficiently continues to accelerate. As laboratories strive to protect patients’ health and deliver safe blood and blood components to the right person at the right time, they are under constant pressure to do more with less—including fewer skilled laboratory technicians and scarcer financial resources. A dedicated focus on overall hemovigilance while ensuring process efficiency is of utmost importance to blood banks in maintaining a safe and accessible blood supply.
WORKFORCE CHALLENGES
Over the past 2 decades, there has been a continued shortage of highly skilled technologists and scientists entering the laboratory science workforce. This is especially true in transfusion medicine laboratories. According to the American Society for Clinical Pathology, labs are currently experiencing the largest number of vacancies, at more than 11%. Intriguingly, low- and medium-volume laboratories have high vacancy rates for medical laboratory technicians while high-volume laboratories continue to have high vacancy rates for most other positions. The same study found that for more than 20% of blood banking laboratories nationally, it can take more than 1 year to fill supervisor vacancies.
Hiring and retention are at the root of the problem, as 43% of the nation’s clinical laboratories reported difficulty finding qualified candidates. In addition, the number of training programs to prepare students for laboratory careers is shrinking, leaving fewer options for those who are interested in entering the field. Another key contributing factor to the decrease in available skilled lab professionals is age. Today, the average age of the laboratory workforce is about 50, and retirement is just around the corner. Lack of visibility and unfamiliarity with the profession are other key factors preventing new workers from pursuing careers in laboratory science.
HOW AUTOMATION CAN HELP
As the labor force shrinks, the rapidly evolving field of laboratory medicine is struggling to keep pace with the growing demand for blood and its components. One out of seven hospital patients requires a blood transfusion, and that translates into 4.5 million patients who need blood every year. In each of these instances, there are myriad quality control processes, from screening to storage and delivery, that must be upheld to keep these blood products safe and available for the patients who need them most.
Ortho-Clinical Diagnostics introduced its “Bloodlines” campaign at the recent AABB annual meeting.
(Photo credit: (c) Ortho-Clinical Diagnostics Inc. Used with permission)
To help meet the growing demands for safety and efficiency, automation is becoming a more standard part of blood bank laboratories because it can help eliminate the labor-intensive, time-consuming manual testing processes that require specialized skills and significant experience to master, such as infectious-disease testing on donor units, patient and unit typing, antibody screening, and cross-matching. Automation also frees up technologists’ time to focus on time-sensitive emergency situations, difficult patient work-ups, and quality-improvement processes. Ultimately, automated testing can increase the lab’s capacity, allowing it to serve more patients while helping it to operate more efficiently. The difference can be dramatic. A recent study from Ortho Clinical Diagnostics, Raritan, NJ, found that on average, one operator using the automated ORTHO ProVue® analyzer was able to perform the same serological testing previously performed by two technical staff members, while reducing total processing time by 40%.
To meet rigorous compliance standards and provide blood and blood products that are safe, most blood banks are also turning to standardization across instrument platforms and implementing testing technologies such as Column Agglutination (CAT). These testing methods are easier to use, and help reduce the opportunity for error and variation among technologists and tests because they provide stable and clear end points that are highly precise while delivering objective, consistent results.
OPTIMIZING PERFORMANCE THROUGH SERVICE SOLUTIONS
To operate at peak performance, today’s blood banks also need the expert service and support that complement this new generation of technological solutions. To maximize a laboratory’s productivity, there is a growing need for technologies that reduce the potential for instrument downtime and prevent workflow interruptions to ensure that instruments are available when needed. One example of a tool that helps achieve these goals is Ortho’s Remote Monitoring service, which provides a real-time, secure, two-way interactive connection between instruments in a lab and a technical support team. Using a mix of sophisticated predictive software and human operators, these monitoring centers keep watch over the function of a lab’s instruments, proactively alerting lab managers when a problem might arise and scheduling maintenance visits during off-peak hours in order to maximize instrument uptime.
PRIORITIZING SAFETY
Screening blood and its components to ensure that they are free of infections, disease, and parasites, and compatible with the blood type, antigens, and antibodies of the patient who needs the transfusion are the highest concern for any blood bank. And, despite workforce challenges in laboratories, significant progress has been made in blood safety during the past few decades. For example, the UN Millennium Project set goals for blood safety and availability, including measures to reduce the risk of receiving infected blood through a transfusion, protocols to avoid unnecessary blood transfusions, and policies to exclude high-risk donors, which must be met internationally by 2015.
In addition to internal quality control processes, many facilities are joining hemovigilance programs to help identify risk factors along the blood transfusion chain. While there are many different definitions for hemovigilance, it is primarily used to describe the process to examine the safety of the blood supply from a donor’s vein until it reaches an intended recipient’s vein. Hemovigilance programs such as the United Kingdom’s Serious Hazard of Transfusion program and the US’ Center for Disease Control (CDC) National Healthcare Safety Network (NHSN) are voluntary reporting structures intended to create a reliable source of information for the medical and scientific community about blood transfusion issues, including warning facilities about adverse events that could be systemic. NHSN, launched in 2010, is the first and only US collaboration in the United States between government and nongovernment agencies designed to confidentially track adverse reactions and incidents associated with blood collection and transfusion. Hemovigilance programs also are intended to indicate corrective measures required to prevent the recurrence of accidents in the transfusion process, ultimately improving blood safety standards.
Most serious hazards of transfusion are due to human errors and tend to happen outside of laboratories that use automated instruments to address these issues. Many transfusion services are implementing a quality or compliance officer to limit such errors by collaborating with medical, technical, paramedical, and nursing personnel to identify, implement, and evaluate strategies for blood conservation and safety. Similarly, hospitals are beginning to establish a similar high-level safety/quality control role, the transfusion safety officer (TSO), to oversee work outside of the laboratory to improve patient safety during transfusions.
Currently, there are only 35 to 40 dedicated safety/quality control personnel in the United States. Aside from France, where there are 2,000 hemovigilance correspondents employed throughout the country, most European countries are similar to the United States, with limited safety/quality control resources. The trending rise in demand for blood and blood components suggests that additional quality control personnel will be needed to promote transfusion safety across departments, oversee institution-wide hemovigilance, error and accident reporting, provide education on transfusion reactions, implement guidelines, perform safety training, and identify new technology for enhanced safety. The role of the TSO is in a nascent stage, but the vision is for a resource that can help usher in universal performance standards for sample collection and blood administration to prevent common transfusion errors.
A SHARED COMMITMENT TO PROTECTING LIFE
As the industry dynamics of blood management continue to change, laboratories will need partners who are in tune with their unique challenges and can support their evolving requirements. That means not only innovating next-generation technologies and automated systems that are intuitive, flexible, and designed to be an extension of the laboratory’s team, but also backing up new solutions with evidence that gives blood bankers certainty about their results.
RECOMMENDED READING
- BloodSource. Blood Facts: Quick Facts. Available at: www.bloodsource.org/BloodFacts/Theneedforblood.aspx. Accessed October 28, 2011
- Casina TS, Sorenson L, Fobare S,. Transfusion. 2002, 42 (suppl): 131S
- Davey RJ. The Safety of the Blood Supply. Food and Drug Administration Division of Blood Applications Webinar. Available at: www.fda.gov/downloads/AboutFDA/Transparency/Basics/UCM245738.pdf. Accessed October 20, 2011.
- Dzik S. Non-infectious serious hazards of transfusion. Blood Bulletin. May 2002;5(1).
- Fridey JL. The transfusion safety officer. Paper presented at: AABB annual meeting. Ortho Clinical Diagnostics Blood Management Symposium. October 24, 2011; San Diego.
- Garcia E, Bennett A, DeFranco M, et al. American Society for Clinical Pathology’s 2011 vacancy survey of US clinical laboratories. Laboratory Medicine. 2011;42(4):199-206.
- Millennium Development Goals—interventions by area. Available at: www.unmillenniumproject.org/documents/MainReportChapter19Appendixes-lowres.pdf. Accessed November 8, 2011.
- National Hemovigilance Program Launches to Track Adverse Events Associated with Blood Transfusion [Press release]. 2010. Available at: www.aabb.org/pressroom/pressreleases/Pages/pr100218.aspx. Accessed November 8, 2011.
- Nel TJ. Managing blood transfusion needs: Hemovigilance. Medscape Today. Available at: www.medscape.com/viewarticle/580997_4. Accessed October 17, 2011.
